Comparing outcomes of ureteral rest to ureteral stent placement prior to robotic pyeloplasty for ureteropelvic junction obstruction

Introduction: To determine whether ureteral stent placement versus ureteral rest for pre-operative management of ureteropelvic junction obstruction (UPJO) prior to robotic pyeloplasty affects peri-operative or post-operative outcomes. Methods: Patients undergoing robotic pyeloplasty for symptomatic UPJO at a single academic centre from 2009 to 2021 were retrospectively reviewed. Patients were grouped based on placement of ureteral stent for UPJO prior to robotic pyeloplasty. Patient demographics and characteristics were gathered. Univariate, multivariate, and Kaplan–Meier analyses were performed. Results: 192 patients were analysed. There were no differences in pre-operative demographics or characteristics between groups. There were significant differences in operative time (227 vs 210 minutes, p < 0.0001) and frequency of ureteral fibrosis requiring ureterolysis (13.6% vs 8.8%, p = 0.0025) between groups. There was no significant difference (p = 0.1342) in pyeloplasty success when stratified by pre-operative ureteral stent placement. Conclusions: Robotic pyeloplasty for UPJO can be performed safely and with similar outcomes following pre-operative ureteral stent placement compared to percutaneous nephrostomy tube (PCN) or no stent. Patients should not be limited to the traditional practice of PCN placement for management of UPJO prior to pyeloplasty when a stent or nephrostomy is required before pyeloplasty. Level of Evidence: Cohort study.